Obstetrics - Screening

Question 1

Booking visit

Answer 1

Before 12 weeks

Lifestyle advice
- Alcohol and smoking cessation

Supplements advice - Folic acid

Maternal screening

Gestational DM screening

Discuss foetal chromosomal screening

Question 2

Maternal screening at booking visit

Answer 2

Anaemia
Sickle cell
Thalassaemia

GESTATIONAL DM!

Hep B
HIV
Syphilis

Question 3

Reasons to screen for gestational DM

Answer 3

BMI > 30
Previous GDM
Previous baby > 4.5kg

FHx

Mediterranean
Afro-Caribbean
South Asian

Question 4

Combined test

Answer 4

10-14 weeks

Nuchal translucency
Papp-A
HcG

Downs = Thickened translucency + ^ HcG + LOW PAPP-A

Question 5

Quadruple test

Answer 5

After 14 weeks

AFP
HcG
uE3
Inhibin

Question 6

Define high risk

Answer 6

1 in 150 to less than 1 in 2

Question 7

Further screening methods

Answer 7

Chorionic villous sampling

• 11-14 weeks
• Cells from placenta

Amniocentesis

• 15 weeks
• Cells from amniotic fluid

Anomaly scan for all women at 18-20 weeks

Question 8

Small for gestational age

Answer 8

AC or EFW < 10th centile

Question 9

IUGR

Answer 9

Growth is normal in early pregnancy
Slows in utero

At least two measurements taken three weeks apart

Question 10

IUGR maternal risk factors

Answer 10

Age < 17 or > 35

Lower socioeconomic class

Weight before pregnancy < 50kg or > 75kg

Smoking, alcohol, drugs

Previous low birth weight baby

Anaemia
HTN

Question 11

IUGR foetal risk factors

Answer 11

Multiple gestation
Chromosomal abnormality 
Congenital infection 
TORCH 
HIV 
Malaria 
Placental dysfunction

Question 12

IUGR management

Answer 12

Foetal monitoring ^
Umbilical artery doppler

Maternal steroids if considering early delivery

Close monitoring during labour - CTG

Question 13

IUGR compilations

Answer 13

Meconium aspiration 
Hypothermia 
Jaundice 
Feeding difficulties 
NEC 
Sepsis 

Cerebral palsy
Learning difficulties
Behavioural problems

Question 14

Normal pregnancy

Answer 14

40 weeks following the last menstrual period

1st trimester - LMP to 12 weeks
2nd trimester - 13 weeks to 27 weeks
3rd trimester - 28 weeks to birth

Question 15

CVS changes during pregnancy

Answer 15

RBC ^
WCC ^
Platelets ^

Albumin - LOW
Urea - LOW
Creatinine - LOW

Cardiac output ^
Stroke volume ^
Heart rate ^

Tidal volume ^

Question 16

Other physiological changes during pregnancy

Answer 16

Skin pigmentation ^

Breast and nipple enlargement

Decreased gut motility
GFR ^

Water retention

Temperature ^

Question 17

Testing schedule

Answer 17

< 12 weeks - Booking visit

11-13+6 weeks - Combined test
15-20 weeks - Quadruple test

10-13+6 weeks - Chorionic villous sampling
> 15 weeks - Amniocentesis